Multidirectional Shoulder Instability
Lennard Funk & Kathleen Roney, 2008
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Definition (Neer) = Abnormal amount of excursion of the humeral head on the glenoid in all directions
Classification - Neer
Group I Antero-inferior dislocation / Posterior subluxation
Group II Postero-inferior dislocation /Anterior subluxation
Group III Global dislocation
Definitions
- Instability = a symptom, usually one direction
- Laxity = a sign, usually multidirectional
- Multidirectional Instability - VERY Rare
Stanmore Classification (Bayley Triangle)
Examination
- Laxity - using Cofield's technique
- Gagey Test for Inferior capsule
- Muscle Patterning
- Kinetic Chain
- Generalised Hypermobility (Beighton Score)
Investigations
In all cases: X-Ray (AP and axillary views), MR Arthrogram
If indicated: CT scan, EMG's, EUA & Arthroscopy
Decision Making
- Polar Type I = Surgery (+ rehab)Management
- Polar Type III = Specialist Shoulder Physiotherapy
- Polare Type II = combination of above (needs skillful and careful management)
Shoulder Therapy
Concentrates on:
- Core stability
- Scapula Stability
- Muscle patterning
- Proprioception
- Functional Rehab.
Combined Rehab exercises incorporate Core stabilty, Proprioception, Scapula, ROM, Strength
See more here
Surgery
Treat ALL Pathology present:
- Labral (Anterior, Posterior, Superior)
- Capsule Laxity
- HAGL
- Bone Defects (Humeral Head, Glenoid)
- Cuff tears
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